MD Mag: What is the role of telehealth in the current landscape of ophthalmology?

Telehealth is critical for many of the diseases that affect more than just our eye patients. So many of our world have diabetes and diabetic eye disease is blinding. It's very hard to reverse if it's diagnosed late, so physicians of every specialty really agree that diabetic people with diabetes should have their eyes screened regularly every 1 to 2 years. So, telemedicine has provided a great opportunity to do that screening at the primary provider site and our government is now paying for that screening and so it's really there's a mechanism to do that. We've been screening people for diabetic eye disease for years and our veteran system successfully and really have helped people prevent going blind by identifying their disease early.

So, that's where really telling about us and ophthalmology started but now we're seeing expansion into other spaces such as retinopathy of prematurity. So, premature babies can now be seen with photography and really prevent blindness even from prematurity, which has been amazing using telemedicine for that purpose. We’re seeing expansion into macular degeneration and other diseases even screening for diseases or more my clinical focus which is corneal diseases of the front of the eye.

What are some of the noteable disadvantages of telehealth at this time?

Health for diabetic eye disease is not in its infancy actually. It is very mature we've been successfully doing these programs for years and years and years. However we've been doing them in systems where they're funded so the Veterans Health Care System the Indian Health Services system, the problem has all centered. The pitfall is it costs money and as opposed to the reimbursement system that we have for seeing patients one on one, we really don't have a good system for making sure that the primary care team is making sure that the cameras get covered. So, it's very hard to implement these systems even though we know that they work and we know that they are as good as clinical care for screening for this disease now it only screens for that one disease diabetes but the pitfall is that we don't have a way to implement it in our nation. we could be really finding more disease and helping more people now. The pitfalls and for other diseases you have to make sure that before you implement it on real patients you've got really good accuracy and validity and that takes time and a lot of money to conduct those trials but I think it's really promising. If, we're talking about the health of our nation I think it'll be pivotal to identify people's diseases.

The other real pitfall is that people focus a lot on screening but they don't focus on follow-up. So, it's very easy to find disease in people, it's a lot harder to then that have those sick people come in to see you both from a provider perspective of incorporating that huge extra volume of patients but more importantly from a patient perspective of these the people who you find on screenings are typically the people who are not coming in in the first place. So, there's all the barriers coming in and so the pitfall is really that, right now, we're focusing so much on screening people and not on getting them follow-up.